Provider Demographics
NPI:1205824398
Name:BRAID, STANTON MARC (D MD)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:MARC
Last Name:BRAID
Suffix:
Gender:M
Credentials:D MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 LOCUST ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3727
Mailing Address - Country:US
Mailing Address - Phone:215-735-6241
Mailing Address - Fax:215-735-6242
Practice Address - Street 1:1521 LOCUST ST
Practice Address - Street 2:SUITE 600
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-3727
Practice Address - Country:US
Practice Address - Phone:215-735-6241
Practice Address - Fax:215-735-6242
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018002L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060873000OtherPA BC-BS- KHPE-PERSONALCH
PA0005238080001Medicaid
PA411837ZN71Medicare PIN
PAT28476Medicare UPIN